CHILDHOOD OBESITY NEWS

SPOTLIGHT

Study establishes link between screen time and specific measures of physical fitness

July 16, 2012, Time

By Alexandra Sifferlin

The more TV kids watch in early life, the thicker they get around the waistline and the weaker their muscle strength, a new study finds.

It’s no secret that watching TV is linked with some unhealthy outcomes in kids—previous studies have found that children who watch more television are more likely to eat junk food, have trouble sleeping and become obese—but the new study, published in BioMed Central’s open access journal International Journal of Behavioral Nutrition and Physical Activity, establishes a link between screen time and specific measures of physical fitness.

“We already knew that there is an association between preschool television exposure and the body fat of fourth grade children, but this is the first study to describe more precisely what that association represents,” said senior author Dr. Linda Pagani, a researcher at the Sainte-Justine University Hospital Research Center, in a statement.

The researchers looked at 1,314 kids who were participating in the Quebec Longitudinal Study of Child Development. The parents of the kids reported the number of hours they spent watching TV each week: at the start of the study, when the kids were 2.5 years old, they were watching about 8.8 hours of TV per week on average. Over the next two years, TV time increased by six hours to 14.8 hours weekly on average. By age 4.5, about 15 percent of the kids in the study were watching more than 18 hours of television each week.

The more time kids spent in front of the TV, the larger their waistlines, the researchers found: each additional hour of weekly TV logged between age 2.5 and 4.5 was linked with an increase of waist size of slightly less than half a millimeter by the time the kids were in grade school. So, a child who watches 18 hours of television at 4.5 years old will have gained an extra 7.6 millimeters (0.3 in.) around his middle by age 10.

Fractions of inches may not sound like much to worry about, but even small increases are significant on child-size bodies, and over time, these little changes add up. Waist size in particular is known to be associated with overall obesity and also with measures of visceral fat, the type of fat that hides around the organs deep in the gut and is especially risky to health.

“Our study is the first to look specifically at waist measurements,” says lead author Dr. Caroline Fitzpatrick. “The weight around the waist is particularly dangerous in terms of cardiovascular and metabolic health.”

The researchers measured both waist size and another indicator of physical fitness: explosive leg strength. When the kids were 8.5 years old, the researched gauged their performance on the standing long jump in order to measure their leg-muscle power, a key contributor to sports ability. Kids who watched more TV as preschoolers were more likely to end up in the bottom 5 percent of long-jump performance: each hour spent watching TV per week at age 2.5 corresponded to about a third of a centimeter loss in jumping distance.

That’s important for all kids, not just those who want to play soccer or basketball. Muscle power is associated with other markers of health and fitness: according to Fitzpatrick, if you have good muscle fitness, you’ll also have better cardiovascular fitness and be less susceptible to injuries. The authors write:

This suggests that for some children, excessive television exposure was associated with the experience of a substantial level of impairment. This finding is of concern given that explosive leg strength is a robust indicator of individual general muscular strength. Eventually, reduced muscular strength that persists into adulthood can predict a number of negative health outcomes.

“Kids who watch more TV are known to be less involved in physical activity and less inclined to play sports, but we found there is actually a potential risk in decreasing their athletic performance with too much television,” says Fitzpatrick. “This can influence their health as adolescents and adults.”

Fitzpatrick says the findings are concerning since young kids are still undergoing through muscular and skeletal development. “It’s a move it or lose it problem,” she says.

The American Academy of Pediatrics recommends that children over age 2 watch no more than two hours of television per day; younger kids should watch no TV at all. Each hour a kid spends planted in front of the tube is an hour he or she isn’t exercising, playing or doing any other constructive activity like reading. “When it’s cold outside, you want a kid to throw on their snow gear and go play instead of preferring to stay inside to watch hockey on TV,” says Fitzpatrick.

NCCOR members selected to receive NIH Merit Award

Aug. 2012, NCCOR

At the end of the year, a number of NCCOR members will be recognized for their contributions to the field of childhood obesity research. The Department of Health and Human Services (DHHS) Energy Balance Provider Survey Collaborative Working Group has been selected to receive a 2012 National Institutes of Health (NIH) Merit Award. The working group includes 11 NCCOR members.

The group, nominated by NCCOR Senior Leadership member Dr. Robert Croyle, will receive the award in recognition of their outstanding leadership in the development and implementation of a nationally representative assessment of primary care physicians’ practices related to energy balance.

PUBLICATIONS

Population-level intervention strategies and examples for obesity prevention in children

July 18, 2012, Annual Review of Nutrition

The purpose of this review is to provide a summary of population-level intervention strategies and specific intervention examples that illustrate ways to help prevent and control obesity in children through improving nutrition and physical activity behaviors. Researchers and practitioners may use this review as they set priorities and promote integration across settings and to find research- and practice-tested intervention examples that can be replicated in their communities for childhood obesity prevention.

RESEARCH HIGHLIGHTS

Sports promote healthy weight in teenagers

Teenagers can significantly lower their likelihood of being overweight or obese by walking or biking to school and playing on at least one high school sports team, but preferably two or more, a new study suggests.

Though the spread of childhood obesity in the last decade has spurred health authorities to ramp up their efforts to promote youth activity, the new findings are among the first to demonstrate that walking or riding a bike to school actually has an impact on weight gain among high school students. The study also found that while school-based exercise can reduce or stem weight gain, it is sports participation in particular that makes a difference. Physical education classes, the researchers found, did not reduce or prevent weight gain, likely because they do not offer students the same level of regular, challenging exercise as competitive sports.

“I think being a part of some kind of team or organization gives kids the opportunity to have moderate to vigorous activity consistently,” said Keith M. Drake, an author of the study and a postdoctoral research fellow at the Hood Center for Children and Families at the Geisel School of Medicine at Dartmouth. “I think a lot of time physical education requirements are not that strict. Kids are not in P.E. that often, and when they are, the physical activity is not that strenuous.”

In their study, which was published in the journal Pediatrics, Dr. Drake and his colleagues tried to quantify the impact that greater sports participation and less reliance on mass transit might have on childhood obesity. They calculated that if all adolescents played on at least two sports teams per year—in other words, one team per season—obesity rates would plunge 26 percent and the prevalence of overweight adolescents would fall by 11 percent. And if all adolescents walked or biked to school at least four days a week, they found, the number who were obese would drop by 22 percent.

Nationwide, about a third of high school students are overweight or obese, a figure that has prompted federal efforts to boost physical activity of any kind among teenagers. Health officials recommend that children get an average of about one hour a day of moderate to vigorous activity, but most fall far short of that.

One of the government’s most recent efforts to boost adolescent exercise was a $100 million-a-year program called Safe Routes to School, which targets the way students commute. In 2001, less than 16 percent of children between 5 and 15 walked, biked or “actively” commuted to school, compared with about 50 percent of youngsters in that age range 40 years ago. Created in 2005, Safe Routes aims to boost those numbers by helping communities build more sidewalks, bike paths and other “pedestrian friendly” routes.

Yet past studies have generally found that while walking and biking to school increases physical activity levels, it has little or no impact on body weight. Dr. Drake and his colleagues noted that the sample sizes in those studies were small—in many cases, just a few hundred students—so recruited over 1,700 high school students and their parents to examine the relationship between commutes to school, levels of sports participation and body weight.

Over all, only 10 percent of students in the study were “active” commuters, walking or biking to school more than three-and-a-half days a week; most, about 70 percent, said they never did either. Active commuting, the study found, lowered the risk of obesity by 33 percent, though it did not seem to protect against being overweight.

“We found that it’s only affecting kids who are near the obesity cutoff,” Dr. Drake said. “We think that’s because walking and biking to school are fairly leisurely exercise and kids don’t tend to do it unless they live close to school. So we think it’s only affecting kids who are very overweight, whereas for most normal kids it wouldn’t affect them.”

As for more organized activities, about 17 percent of the students played on one sports team, 18 percent played on two, and 35 percent were on three or more. The study revealed a dose response relationship: the greater the participation level in organized sports, the lower the risk of being overweight or obese. The trend became most significant when students played on at least two teams, representative of year-round participation in sports.

“Playing on one sports team is definitely better than playing on zero, but I would say at least two or three is probably ideal,” Dr. Drake said.

Dr. William Stratbucker, the medical director of the Helen DeVos Children’s Hospital Healthy Weight Center in Grand Rapids, Mich., who was not involved in the research, said the findings were intriguing because they showed a sort of threshold for effective physical activity. But he said the idea that every child should join a sports team “is not achievable in real life.” Some children may face economic barriers, like the costs associated with team sports, or health issues, like asthma, that limit their participation.

Another way to encourage vigorous exercise among teenagers, Dr. Stratbucker said, is for parents to make it a part of their lives. “If the parents are enjoying an active lifestyle themselves, that’s modeling behavior that leads to children participating in activity to the levels that they need to be,” he said.

Not every student can make the varsity baseball or basketball team, Dr. Drake said, but there are other ways—like playing intramural or club sports, or joining a dance or gymnastics team—for children to get strenuous exercise.

“I don’t think it has to be a sports team,” he said. “There are other athletic opportunities, even for the noncompetitive kids, that can achieve the same benefit.”

Seeing certain foods prompts kids to eat healthier

July 25, 2012, Health by Medical Xpress

By Stacey Shackford

Just because healthful foods are available in school cafeterias doesn't mean children are going to eat them, but in some cases, the very presence of such foods as whole fruit may actually prompt kids to make healthier choices, even if fruit is never selected.

A study by researchers at Cornell's Center for Behavioral Economics in Child Nutrition Programs (BEN Center) found that the mere presence of applesauce and fruit cocktail on the school lunch line sent students to seek out sugary snacks, increasing the number of cookies, ice cream bars, and Little Debbie snack cakes they purchased, while green beans and bananas inspired them to make more healthful choices.

“The impacts of offering a single vegetable or fruit may have significant implications for the whole meal,” said study co-author Andrew Hanks, a postdoctoral researcher for the BEN Center.

“Even though these students did not take a fruit or vegetable, either in a meal or as a separate item, their choices of the less healthy a la carte items were still affected by the presence of fruits and vegetables,” said BEN Center co-director and study co-author David Just. Brian Wansink, the other co-director, is also a co-author.

The study, published in the April edition of the Agricultural and Resource Economics Review, analyzed school lunch purchase data from two schools in upstate New York.

The authors hypothesized that the children's choices could be the result of the “priming effect.” The sweet nature of applesauce and fruit cocktail might have led the children to be drawn to other items with greater sugar content, while the green beans and bananas could cause the student to think about healthful foods.

Although the exact foods that trigger behavior may differ from cafeteria to cafeteria, the principle is that relatively more healthful items trigger healthier choices and vice versa.

The findings build upon previous studies by Just and Wansink that have found that environmental cues such as visibility, convenience and accessibility can affect behavior in systematic ways.

“Trigger foods may fly under the radar, influencing choice without overtly drawing the attention of the decision maker, but they can have substantial effects on the nutritional content of the food selected,” Wansink said.

Just added that the behavioral anomaly could be exploited to lead children to eat better. This information can be most useful for food service directors as they strive to identify which options will help students make the most healthful choices, he said.

The research was supported by the U.S. Department of Agriculture's Economic Research Service and Food and Nutrition Services.

Childhood obesity may lead to early puberty

Aug. 1, 2012, Medical Daily

By Amber Moore

Childhood obesity may disrupt timing of puberty in girls, a new study says.

According to the researchers, rising obesity among children can lead to poor reproductive systems. Previous research has shown that childhood obesity can lead to health complications like glucose intolerance, hypertension and high cholesterol. Now, researchers say that these metabolic conditions might affect the reproduction system as well.

“The issue of so many humans being obese is very recent in evolutionary terms, and since nutritional status is important to reproduction, metabolic syndromes caused by obesity may profoundly affect reproductive capacity,” said Patrick Chappell at Oregon State University and an author of the recent report, according to a statement.

“Either extreme of the spectrum, anorexia or obesity, can be associated with reproduction problems,” Chappell said.

One theory about why there is variation in timings of puberty is that normal secretion of a key hormone called kisspeptin is necessary for reproduction might be disrupted in children who have excess fat.

Previous studies have shown that childhood obesity is associated with risk of early menarche in girls.

Early menarche has been associated with heart diseases, cancer, adult onset of diabetes and depression. It can also affect lung function and result in adult asthma. Research has shown that early age menarche tend to cause behavioral problems that stay for long time.

“Any disruption of circadian clocks throughout the body can cause a number of problems, and major changes in diet and metabolism can affect these cellular clocks. Disruption of the clock through diet can even feed into a further disruption of normal metabolism, making the damage worse, as well as affecting sleep and reproduction,” Chappell said.

Researchers say that more studies are required to understand how obesity affects reproductive system.

NYC ban on super-sized sodas would cut consumers' calories: Study

A day before a public hearing on New York City's proposed ban on super-sized restaurant sodas, a new analysis finds that such a ban would spare consumers excess calories.

The proposed rule put forward by Mayor Michael Bloomberg would restrict the sale of sodas and other sugary drinks to servings of 16 ounces. While nutritionists applauded the move, critics see it as another step toward a nanny state. The New York City Department of Health and Mental Hygiene has scheduled a public hearing on the issue for July, 24.

Amid all of this, the real impact of reducing serving sizes is unknown. Now, three researchers from New York University have tried to quantify the effect by creating several scenarios.

“We wanted to give a sense of [what] the impact of the Bloomberg soda policy might be on consumer purchases,” said researcher Brian Elbel, an assistant professor of medicine and health policy at NYU School of Medicine.

The report was published online July 23 in the New England Journal of Medicine.

To do this, Elbel's team focused on purchases of these drinks at fast-food restaurants.

The investigators found that if everyone switched from 32-ounce drinks to 16-ounce drinks, they would consume 63 fewer calories every time they bought a fast-food meal.

If, however, no one switched that would actually boost the number of calories they consume by about 30 calories more, Elbel said.

Elbel admitted that 63 fewer calories is just a drop in the bucket. “We know this alone is not going to bend the obesity curve in any large-scale way. That said, 63 is not nothing. It's a reasonable number to expect from any single policy,” he said.

“If you get a few different policies that have this impact, then they could have a much larger impact overall,” Elbel added.

The Bloomberg proposal has been criticized as limiting freedom of choice and another intrusion on the lives of citizens.

But, Elbel said, if the tide of the obesity epidemic is to be turned, government will necessarily be involved.

“A lot of what is influencing obesity is not that suddenly consumers just became weak-willed and started eating a lot, he explained. A lot of it has to do with the availability of large portions of unhealthy foods everywhere people look.

“Given that's what is driving a lot of obesity, it's hard to imagine a scenario where that gets better without some government intervention,” Elbel noted.

“There are always going to be tradeoffs between individual choice and liberty and the government's role in protecting the health of its citizens, and the larger social and economic impact obesity can have,” he said.

This is a policy that directly attacks portion size, Elbel stated.

If you are a consumer who wants a lot of sugar-sweetened beverages, you can still do that; this just makes it a little more of a hassle to do so, he added. For consumers who aren't so driven by that want for 32 ounces, it could have some positive impact on their health.

Commenting on the report, Dr. David Katz, director of the Prevention Research Center at Yale University School of Medicine, said: While some of the strong reactions to Mayor Bloomberg's proposed ban on large sodas in New York City may suggest otherwise, neither the Mayor nor anyone else in public health cares about beverage size, per se.

The real issue here is the calories feeding the obesity epidemic, and what actionable steps will help slow their seemingly inexorable flow, Katz said.

“The analysis by Elbel and colleagues suggests that, under most likely scenarios, calorie consumption would decline if the policy were implemented. Of course, this analysis cannot predict all potential responses, such as an increase in calories from other sources, but it does lend the weight of at least predictive data to the Mayor's side of the argument,” he added.

Almost one-third of Americans are obese, according to the U.S. Centers for Disease Control and Prevention. Obesity increases the risk for type 2 diabetes, high blood pressure, heart disease and some cancers and other medical conditions.

CHILDHOOD OBESITY NEWS

Despite obesity concerns, gym classes are cut

July 10, 2012, The New York Times

By Al Baker

More than a half-century ago, President Dwight D. Eisenhower formed the President’s Council on Youth Fitness, and today Mayor Michael R. Bloomberg and Michelle Obama are among those making childhood obesity a public cause. But even as virtually every state has undertaken significant school reforms, many American students are being granted little or no time in the gym.

In its biennial survey of high school students across the nation, the Centers for Disease Control and Prevention reported in June that nearly half said they had no physical education classes in an average week. In New York City, that number was 20.5 percent, compared with 14.4 percent a decade earlier, according to the C.D.C.

That echoed findings by New York City’s comptroller, in October, of inadequate physical education at each of the elementary schools that auditors visited. Researchers at the University of California, San Francisco, found just 20 percent of elementary schools in San Francisco’s system were meeting the state’s requirements: 20 minutes per day.

At Anatola Elementary School in Van Nuys, Calif., not only are there no gym teachers, but there is also no gym. The principal, Miriam King, has relied on $15-an-hour aides to oversee once-weekly exercise regimens for her 450 students at an outside playground.

“Sometimes, when it is raining, we just cancel,” Ms. King said.

In the Miami-Dade School District in Florida, physical education classes for middle school students were threatened by state legislation last year, in the face of anemic local tax collections and dropping property values. But the district’s top health educator, Jayne D. Greenberg, watched in thankful relief as a grass-roots effort mounted enough political pressure to beat back the proposed cuts.

Still, Dr. Greenberg said, she has had to “double up some of the elementary physical education classes.”

In East Harlem, at TAG Young Scholars, an elementary and middle school for gifted students, there was no gym teacher for elementary students, according to Patricia Saydah, whose son Mitchell Deutsch just finished the first grade there. Art teachers and guidance counselors oversaw the classes, and students were sometimes called on to demonstrate stretching, Mitchell said. Next year threatens more hardship: One of the four schools that share TAG’s building is expanding, further straining the sole gym.

Ms. Saydah said she was concerned with Mitchell’s ability to focus in class without physical activity most days.

“He comes out of school and he is bouncing off the walls,” she said.

Senator Tom Harkin, Democrat of Iowa, has proposed injecting language into the federal budget creating incentives for schools to report how much physical activity students are getting. He also asked the Government Accountability Office to look into the issue and, in February, it released a survey showing that while schools appeared more aware of the benefits of physical education, “they have reduced the amount of time spent” on such classes.

Principals most frequently blame budget cuts, and in New York, they also cite pressures to devote resources to test preparation, and what one union leader called a lack of interest from the department headquarters.

“There does not appear to be a promotion, or support, from the Department of Education for daily physical education in many of our high schools,” said Jeff Engel, a vice principal at Long Island City High School, in Queens, who is a member of the executive board of the principals’ union. He said that his own school provided daily physical education, but that many did not. “We have a huge obesity epidemic in the city, yet we see many of our high schools going to nondaily physical education.”

According to the city comptroller’s audit, none of the 31 elementary schools that auditors visited were holding physical education classes as frequently as required: every day for kindergarten through third grade and three times a week for grades four through six, for a minimum of 120 minutes weekly; and at least 90 minutes a week for grades seven and eight. In grades 7 through 12, state guidelines call for physical education three times a week in one semester and twice a week in another.

Kathleen Grimm, New York City’s deputy schools chancellor for operations, said the Bloomberg administration required adequate physical education in schools, but acknowledged it had work to do. Since principals face challenges in providing space and time for those classes, she said, the administration hoped to put a plan in place by summer’s end to provide them “better support” across all areas of education, including physical education.

The department has not filed a physical education plan with the state since 1982, though state officials recommend a new one every seven years. A spokeswoman for the city schools says one will be presented in September.

Besides its value in fighting obesity, physical education has also been linked in some studies to good academic outcomes. Dr. John J. Ratey, a Harvard professor and author of “Spark: The Revolutionary New Science of Exercise and the Brain” cited a 2010 study on the topic from the federal Health and Human Services Department.

“There is shrinking P.E. and recess time for our kids,” Dr. Ratey wrote. “P.E. teachers are fighting like cats and dogs to hold the line on their jobs and worth, at the same time as there is a dawning awareness that we have missed the boat.”

Despite the shortcomings in physical education, Mr. Bloomberg has received high marks from public health advocates for his anti-obesity policies, including calorie disclosures in chain restaurants, a proposed ban on large sugary drinks in certain settings, and limits on the calorie and sugar contents of food sold in school vending machines.

In the meantime, the city has promoted several school health initiatives, including 10-minute “fitness breaks” in classrooms and before- and after-school recreation for middle school students. And Ms. Grimm said that the city had been honored, nationally, for a program to assess students’ fitness and that 850,000 pupils had completed the program this year. In December, the city said that annual fitness exams given to most of the city’s kindergarten though eighth-grade students showed a 5.5 percent drop in the number of obese schoolchildren over five years, the biggest decline reported by any large city. Despite the improvements, the study showed that 21 percent of the children were still considered obese.

One elementary school making an effort is Sheridan Academy for Young Leaders, in the Bronx, where Ronny Rodriguez, a physical education instructor, ran 12 students through a rigorous 50-minute class one day last month.

Each student gets class once a week, far short of state requirements. During fitness breaks, students in science class stand and clap to the beat of a heart, and in social studies, they move as if navigating a rain forest.

Still, Mr. Rodriguez and Vicki Weiner, co-chairwoman of the school’s wellness program, wish more days had gym class.

As his perspiring first graders, some visibly overweight, poured out of the gym for the last time, Mr. Rodriguez addressed his “young leaders” and asked what they would do over the summer.

“Exercise!” came the choral reply.

“One day, or every day?” he asked. They replied, in unison: “Every day!”

New York City's proposed ban on big sugary sodas draws heated debate

July 24, 2012, Reuters

By Jonathan Allen

New York Mayor Michael Bloomberg's proposed ban on large sodas is expected to pass in September, but that didn't deter hundreds who showed up on July 24 to either to praise the measure as a way to battle obesity or oppose it as pointless and unfair.

The proposal before the city Board of Health, the first of its kind in the nation, would limit servings of sugary drinks to 16 ounces (473 ml) at most restaurants, theaters, delis, vending carts, and stadium concessions.

With the Board of Health filled with Bloomberg appointees, the proposal is expected to pass when it is put to a vote on Sept. 13.

Many opponents view the measure as unwelcome government intervention—a further incursion of Bloomberg's "nanny state"—while supporters call it crucial to fighting obesity.

The hearing drew hundreds of participants, from public health officials to local politicians and a dentist who reminded the audience that sugary drinks cause cavities.

Opponents such as Melissa Mark-Viverito, a City Council member who represents low-income neighborhoods in East Harlem and the Bronx, said the proposal would unfairly harm small and mid-sized restaurants that sell drinks in large containers.

Critics also say the law would punish lower-income people who rely on the cheaper fare of fast-food restaurants.

"After speaking face to face with restaurant owners, I'm convinced that this ban will have an adverse economic impact on our community's small businesses and could result in job losses," Mark-Viverito said.

"We need to get to the root of the problem, which goes much deeper than the size of a cup of soda," she said, calling upon the city to expand and renovate parks and playgrounds to give residents more opportunities to exercise.

The ban would not apply to convenience, grocery or drug stores, which mostly sell beverages in bottles and cans, and it would exclude diet and dairy-based coffee drinks.

Coca-Cola Co has called the Bloomberg proposal an insult to New Yorkers, and the American Beverage Association, which represents that company as well as PepsiCo Inc and other soda makers, is fighting the measure.

"We believe it is misguided, unscientific, arbitrary and, if adopted, unlawful," said Jim McGreevy of the American Beverage Association at the hearing.

He said Americans are drinking less full-calorie sweetened drinks, yet obesity continues to rise.

Speaking in favor was Kelly Brownell, director of the Rudd Center for Food Policy and Obesity at Yale University, who said sodas are the greatest source of added sugar in typical American diets and have no nutritional value.

"If people are served larger portions, they generally consume more," he said. "This to me is a bold and constructive policy completely supported by scientific evidence."

City officials cite statistics showing 58 percent of New York City adults and nearly 40 percent of public school students are obese or overweight.

During Bloomberg's three terms in office, the city has banned smoking in bars, restaurants and public places, banned artificial trans fats in restaurant food and required calorie counts to be posted at fast-food outlets. Bloomberg also has led a campaign to cut salt in restaurant meals and packaged food.

Opponents accuse the mayor of trying to run a "nanny state." An advocacy group backed by the food and restaurant industries took out a full-page ad recently in The New York Times, depicting Bloomberg as a nanny in a purple dress.

If the measure is approved, the regulations would take effect in March.